When news got out that the latest Senate Republican health care bill, the Better Care Reconciliation Act of 2017, would kill Medicaid expansion by 2020, Monterey County residents enrolled in Medicaid got nervous.

“We started getting phone calls from our patients who are terrified,” says Julie Edgcomb, who’s in charge of clinics for the Monterey County Health Department and Natividad Medical Center. “They were asking, ‘Will you still see us if we lose our health care?’”

Edgcomb estimates that if the Senate bill passes, up to 32,000 Monterey County residents would lose Medi-Cal insurance, California’s version of Medicaid which was expanded under Obamacare. The clinics will still see patients, she says, but she worries about their ability to afford necessary medications and lab tests. County doctors also worry that patients will stay away from routine treatment, instead winding up in hospital emergency rooms, which in turn drives up costs.

Alan McKay is CEO of the Central California Alliance for Health, a $1.1 billion nonprofit that provides Medi-Cal for low-income people in Monterey, Santa Cruz and Merced counties. McKay calls what the bill proposes a “fundamental restructuring” of how the federal government finances Medicaid.

Currently, Medicaid is an open-ended entitlement program. The more that gets spent, the more that is reimbursed. But the Senate bill would install spending caps, which would cause states to restrict who is enrolled and what benefits are included.

Also a concern, McKay says, is that by 2025 the bill would change how the government determines how much to pay for care, using an index which he says would not keep up with skyrocketing medical care costs. The result could be especially harmful to elderly patients in need of long-term care who could run out of benefits to pay for it.

GOP leaders had previously said they would push for a vote by July 4, but on June 27 they abandoned that plan, saying instead they would wait until after the week-long holiday recess.